Junior Doctors’ Pay

Private Members' Business – in the Northern Ireland Assembly at 3:45 pm on 21 May 2024.

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Photo of Nuala McAllister Nuala McAllister Alliance 3:45, 21 May 2024

I beg to move

That this Assembly recognises the valuable work of all staff within Health and Social Care (HSC) Northern Ireland, as well as the unprecedented pressures facing our health and social care system; acknowledges that junior doctors are a vital element of the health system in Northern Ireland; notes that junior doctors in neighbouring jurisdictions currently experience better pay and conditions for less-pressurised workloads than their counterparts in Northern Ireland, causing significant issues for recruitment and retention; further recognises the upcoming strikes are a measure of last resort; and calls on the Minister of Health to urgently and meaningfully engage with the British Medical Association regarding junior doctors' pay, taking account of agreements reached in Scotland and Wales.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make a winding-up speech. All other contributors will have five minutes. Please open the debate on the motion.

Photo of Nuala McAllister Nuala McAllister Alliance

Thank you, Madam Principal Deputy Speaker. I urge the Health Minister to urgently engage personally with the British Medical Association (BMA) junior doctors committee in good faith and with an open mind, not as a box-ticking exercise. While it may be too late to avoid the strike action planned for this week, there is still time to act ahead of the action planned for the start of June.

Secondary care in Northern Ireland is in crisis. The huge waiting lists, growing vacancies in the system and greater remuneration available in other countries are creating an untenable situation for our patients, constituents and health and social care system. Underlying all of that are our healthcare workers: our nurses, our consultants, our auxiliary care workers and our junior doctors, on whom the motion focuses. Junior doctors work in understaffed and under-resourced health systems that face record demands. They work through enormous backlogs of care that were made worse by the pandemic. However, those are not the only pressures that junior doctors face. There are pressures both in the workplace and at home as they try to manage the work-life balance. Many junior doctors have brought that to the conversation about this week's strike and the strike planned for June.

Before I talk about pay and the role of a junior doctor, I will highlight what "junior doctor" actually means, because the title can often mislead. Junior doctors are qualified doctors who are in clinical training. They have completed a medical degree and can have up to nine years of experience working as a hospital doctor. Despite having a "junior" title, their clinical role is anything but. The reality is that, if you have to go to hospital, whether as an inpatient or on a visit to A&E, aside from nurses, you are most likely to be seen by a junior doctor at some stage. Despite playing a vital role in sustaining our health service, our junior doctors are struggling due to the unrealistic expectations put on them.

I now want to talk about pay. The Department of Health confirmed in a statement last week that the vast majority of junior doctors work on rotas that attract an additional almost 50% of their basic pay. Before commenting further on that press statement, I will say that I accept that that 50% in addition to their pay is likely to be the case. However, I will highlight what that means. For a junior doctor to receive a 50% supplementary payment on top of their basic pay, they must do at least 40 to 48 hours per week, including two 12-hour shifts, one set of night shifts and one weekend shift per month. Some junior doctors are on a band 3 wage, and, while they earn a significantly higher pay supplement on top of their basic pay, it comes as a result of working at least 56 hours per week and at the expense of rest periods. That is only if the junior doctors work those noted hours, taking breaks and lunches, which, we know, is not the case. Why? Because they simply cannot leave their patients.

Recently, I visited the children's A&E, where we were seen at 1.00 pm by a junior doctor who had already been on a long shift. The same junior doctor had to transfer shifts and work long past 7.00 pm. We then had a visit from another junior doctor, who had a phone consultation with the junior doctor from the earlier shift to discuss my child's results, because continuity of care is key in diagnosing and seeing the overall picture for any patient or anybody's child. No junior doctor turns down those phone calls, because they understand the importance of that care. On admission, we had another junior doctor come to see us. That doctor had not even had time to take a break to eat that day. Even if they have time to take a break, often there is no facility in which to take it. How do we expect medical professionals to take care of us when they are running on empty?

Photo of Sorcha Eastwood Sorcha Eastwood Alliance

I thank the Member for giving way. Does she agree that junior doctors, especially those working in such speciality areas as haematology and oncology, are the backbone, frankly, of some our services and deserve our support and value at this time?

Photo of Nuala McAllister Nuala McAllister Alliance

I agree with the Member, and I note that she has personal experience, with her husband being under the care of many junior doctors. It is vital that their professional livelihood and work-life balance be taken seriously, given that they deal with the most vulnerable in the healthcare system.

I have outlined what it takes to earn that supplemental income. Does the Minister accept that the wages that junior doctors earn are a result of much longer working hours, antisocial hours and unsafe hours? Will the Minister please confirm how many junior doctors currently work on band 3 rotas? Does he accept that the number of junior doctors working on unsafe and unsocial band 3 rotas skews the average wages that he could quote for junior doctors in Northern Ireland? I hope that the Minister will address those issues.

I want to talk about why we felt the need to bring the matter to the Chamber. Before today, unlike the Minister, I, along with my Alliance colleagues and many colleagues across the Health Committee, have personally engaged extensively with the BMA to understand its reasons for taking strike action. I have touched on the pay issue, but the glaring issue in the process has been the lack of personal engagement with the Minister before today. I appreciate that the Minister is busy and that he has sent officials to meet the BMA and its junior doctors committee on a number of occasions, but the Department of Health has responded to Assembly questions, statements, press and comments in the Committee by stating that the Minister's door always remains open for negotiations. With respect, how can anyone believe that the door was open in the first instance when the Minister neglected to meet the BMA face to face one day before the first strike? For the Department to state a belief, just last week, that it did not accept that the talks have collapsed was, at best, disingenuous and, I can honestly say, at worst, an exercise in gaslighting.

Unfortunately, that is not the only cause of the erosion of trust between the Minister and the Department and the junior doctor workforce. In February, there were issues around implementing the Review Body on Doctors' and Dentists' Remuneration (DDRB) uplift for 2023-24. Back then, junior doctors were told that it would be implemented immediately, but, unfortunately, they learned, as we heard during their visit to the Committee, that it would be implemented in June. I would like to hear from the Minister on that.

I also want to speak about working conditions, although the motion focuses on pay. Two weeks ago, at the Health Committee, we heard from the BMA and junior doctors, who were represented by Fiona Griffin. She highlighted the issues facing junior doctors. That day, you could sense the frustration. In answers to questioning from many members, we learned of further disappointing engagements, such as the engagements with officials around working conditions in which verbal agreements were made, only to be watered down when sent back in writing. You can understand the frustration of junior doctors when they do not feel that they are being listened to in good faith. Furthermore, the Department is sticking to the position that any discussions around pay restoration for junior doctors is a national issue, so we must wait until agreement is found in England and Wales. That is despite the BMA being told by the Secretary of State prior to the restoration of the institutions that he could not engage, because it was a devolved issue. Where exactly do we stand? Both of those statements cannot be true.

That sequence of events left us with no choice but to bring this directly to the Floor. I understand that, in the time between the motion being tabled and today, a number of things have happened. The Minister outlined earlier, at Question Time, that he had met the BMA, and we have had further contact from it. However, we need to be honest, open and genuine, and we need to be willing to discuss pay for junior doctors.

I do not want to pre-empt the Minister's response, but I know what he will probably say. I understand that the Executive face an extremely difficult financial year ahead and that the difficulty is not limited to the Department of Health. However, I reiterate that we will, obviously, need a business case — a proposal — to go forward to the Department of Finance. Why not engage with that first? We need strong leadership. There are plenty of efficiencies to be found in the Department of Health.

Earlier today, we passed the LCM on the Tobacco and Vapes Bill. I recognise that that is a long-term approach, but it does represent an efficiency that can be made in the health system. The Fiscal Council commissioned the Nuffield Trust report, which found that patients in Northern Ireland stay for longer in hospital compared with patients in England and Wales. That is another example of why making efficiencies and investing in domiciliary care saves money in the long term as does the advancement of day procedure hubs and elective surgery hubs. The efficiency of hospital services are also brought to the attention of me and my colleagues when we meet doctors, nurses or anyone who engages in the hospital system. However, the immediate priority must be for the Minister to regain the confidence of the junior doctor workforce.

Before I finish, I thank the junior doctor committee, notably Fiona and Edwina, and previous committee member Noel, who have been engaging with me over the past few days, despite their heavy work schedules and trying to achieve an appropriate work-life balance. One of the junior doctors highlighted how they recently put their house up for sale. They will be relocating their family to England because they want to move to a location that respects them and their work.

Photo of Nuala McAllister Nuala McAllister Alliance

I commend this motion to the House and ask the Minister to get on board in a serious and —

Photo of Nuala McAllister Nuala McAllister Alliance

— respectful way.

Photo of Declan Kearney Declan Kearney Sinn Féin

Labhróidh mé i bhfách leis an rún. Tacaíonn Sinn Féin go huile agus go hiomlán le héilimh na ndochtúirí sóisearacha.

Le blianta beaga anuas, tá pá agus coinníollacha oibre na ndochtúirí seo ag gabháil in olcas. Ní hé amháin gur acmhainní daonna riachtanacha iad na dochtúirí sóisearacha; is iad croílár fheidhmiú an chórais sláinte. Mar sin de, ní mór teacht ar réiteach cuimsitheach ar an chás seo gan a thuilleadh moille agus mar thosaíocht éigeandála.

[Translation: I will speak in favour of the motion. Sinn Féin unreservedly supports the demands of the junior doctors. For some years now, the pay and working conditions of these doctors have been getting worse. Junior doctors are not merely an essential human resource; they are central to the functioning of our healthcare service. Therefore, a comprehensive solution to this matter must be found without further delay and as a matter of the utmost urgency.]

To cut to the chase, I call on the Department of Health to urgently resolve the junior doctors' pay dispute. It is also critical that the poor working conditions endured by so many of our junior doctors are comprehensively addressed at the same time.

Junior doctors play a vital role in the North's healthcare system, a system that is already suffering with very significant workforce planning stresses and pressures. The planned strikes by our junior doctors this week are a stark reminder of how reliant we are upon those essential workers in our hospital and clinical care settings. Our junior doctors correctly believe that they are undervalued, underpaid and overworked. As a result, they have been forced onto picket lines for fair pay and equal treatment. They are demanding that they are given parity with their counterparts in other regions and that their pay reflects those similar arrangements.

Others are choosing to leave the healthcare system entirely and emigrate to other jurisdictions, where they will be valued for being the highly skilled and highly trained professionals that they are. Failure to deliver fair pay and tolerable working conditions for our doctors will make retention impossible. We are losing highly trained medical professionals to other places and jurisdictions where they are being treated with respect, decency and fairness.

In my meetings with junior doctors, including on their picket lines, I have listened to their experiences of a lack of rest periods and a lack of access to even basic showering and washing facilities. Those are the conditions for younger doctors who regularly work far beyond their rostered shifts, many of whom are rearing young families of their own. Leaving junior doctors to work long shifts — many at night, with inappropriate spaces to take a break, have a rest, get something to eat and get a wash — is putting them in an impossible situation. Junior doctors deserve better.

Just like nurses and other healthcare service staff, junior doctors are absolutely central to the sustainability of our healthcare system. The need for the Department of Health to fully engage with them and find acceptable resolutions to this dispute is non-negotiable. It is time for those doctors to be valued and respected and for them to receive fair pay.

Photo of Alan Robinson Alan Robinson DUP

The alarm bells rang in this Building earlier today to call us to order, but it is safe to say that alarm bells are ringing about the future of our health service. Yet another day, yet another crisis in health. The mounting pressures that weigh on our health system make me, as the father of a young child and a citizen of this Province, fear for the future.

As we stand on the precipice of junior doctor strikes, we recognise that such action tends to be a last resort. It is a desperate plea for fair pay and acknowledgement of their sacrifices. Junior doctors state that their counterparts in neighbouring jurisdictions enjoy better pay, improved working conditions and manageable workloads. Therefore, it is no wonder that recruitment and retention have become pressing issues here in the Province. We all hoped that the industrial action that was held earlier this year would have brought matters to a head. There is no question about the vital role that junior doctors play in the health service. I am spooked by the effect that the latest strike action will have on patient outcomes. I fear that the strike will result only in the further loss of those whom we train, such is the frustration among junior doctors. With waiting lists at an all-time high, we need, now more than ever, to retain those whom we train.

The Health Committee recently heard from the chairperson of the BMA's junior doctor committee, who said that there had been no negotiation. She highlighted to the Committee the fact that junior doctors' pay is the lowest in the UK. She said that they were not looking for a pay uplift in one go, and that they would accept an annual uplift with an annual negotiation. We were also told that the DDRB uplift for 2023-24 had not yet been paid, even though the Department had allegedly given a commitment that it would be paid immediately following the restoration of the Assembly. However, it was good to learn that the award will be paid in the June pay run, with the Department now stating that it will be in pay packets next month. I hope that that will be the case. Pay is a central issue of concern, with 72% of junior doctors saying that their current pay makes them more likely to leave Health and Social Care in the Province. The BMA states that staff levels will rise only if we see proper pay rises that make Northern Ireland an attractive place in which to practice medicine. It will be impossible to address waiting lists if we do not have the staff working in the health service.

Although pay is key, so, too, is burnout. At Committee, we were told that coffee and goodwill is currently saving the health service. The Minister, in correspondence with the Committee, said that he will await further clarity on any final settlement in ongoing pay negotiations on the mainland. However, health in Northern Ireland is devolved, so I wonder why we must wait on the outcomes in England, particularly when we see the movement that has occurred in Scotland and Wales. The Minister is on record as saying that below-inflation pay awards are a direct consequence of the austerity policies that have been adopted by the Conservative Government. Each 1% increase in medical pay is currently estimated to cost £6·6 million per annum recurrently. We are all too versed in the financial pressures that face this Administration. The recent Budget announcement, in which Health will receive over half of the total amount allocated to Departments for day-to-day running, has created hope among junior doctors. However, they need more than hope.

There is no question about the vital role that junior doctors play in the health service, but I am spooked by the effect that the latest strike action will have on patient outcomes. I ask the Minister this: what action is being taken to ensure patient safety during the forthcoming strikes? I call on the Minister of Health to keep engaging with the BMA to try to address the concerns of junior doctors, taking inspiration from the agreement that was reached in Scotland and the recent outcome in Wales.

Our junior doctors are valued by everyone in the House, and our citizens should receive the care that they deserve. A balance needs to be struck, but that can be done only with direct engagement by all sides in good faith. I hope, even at this late hour, that, on the back of this debate, the situation can be de-escalated. I very much look forward to hearing the Minister's updated position today.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

The motion is timely, given that strikes will take place across the North tomorrow. The work that our junior doctors do is nothing short of remarkable. Day after day, they go into our hospitals to care for some of the most vulnerable in our society. Countless expectations are placed on our junior doctors. If there are gaps in the workforce, they are expected to fill them, despite possibly having just worked a full shift. They are running from one case to the next for hours on end. As has been explained, they have detailed how, when they get an opportunity to have a break, they have to, at times, go to their car to take that break because there is nowhere appropriate for them to have it. The practices under which we expect them to work are simply not safe.

That does not even touch on what was expected of them during COVID-19. They simply have nothing left to give, and, ultimately, pay has become the tipping point for them. The question for us has to be this: what are we doing to make this place attractive to junior doctors? Of the 7% of medical students who have said that they will remain here after qualifying, what is it that they are going to stay for? Unsafe working practices, unfair pay and countless expectations. One has only to look at the verbal abuse that junior doctors take on social media for having the audacity to expect to receive a fair day's wage to see what they have to endure. I encourage anyone who says that junior doctors are paid enough to spend a day doing what they do. Walk a mile in their scrubs and then tell me that they are overpaid.

Although the SDLP supports the motion, I have some questions about transparency, given that the proposer of the motion's party supported this year's Budget at the Executive. If her party supports giving the Health Minister less than the budget that he needs to provide the pay uplift that we want to see, it is a bit like putting somebody into a fight with one hand tied behind their back. It is not a fair fight.

Photo of Nuala McAllister Nuala McAllister Alliance

Does the Member agree that the Minister would need to put a business case to the Department of Finance but that that has not been the case? There has not been a proposal, an option or anything else put forward for more finance for junior doctors' pay.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member has an extra minute.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I totally agree with that. If the motion simply stated that the Minister should put forward a business case, I would have no problem with that. The motion, however, goes on to state that junior doctors should be given the pay uplift that they require. It asks that the Minister work with the BMA in a meaningful way, which can only mean that junior doctors get the pay uplift that they need. If a four-party Executive are not going to give the Minister the money that he requires to do that, having this debate is a little bit disingenuous, because it is telling those junior doctors, "We are prepared to come in here and fight for you, but, by the way, there is absolutely no money to provide in order for the Minister to deliver". It is therefore a bit difficult to have that discussion. If we truly believe in and value our junior doctors, we would make the money available so that the Department could pay them.

There are going to be picket lines tomorrow. If any Member of the parties that have supported the Budget goes and stands on those picket lines, having voted for a Budget that does not provide the money to support the pay call that the workers are making, that is also a little bit disingenuous. I hope that those who are on the picket lines tomorrow will ask any of the elected representatives there, "Are you voting for the Budget, and is it going to give us the money that we need to get our pay uplift?". If they are going to vote for the Budget, they are simply trying to curry favour by being on the picket lines.

The SDLP has always been consistent in its message that, if we are serious and responsible about delivering full pay restoration, we need to see a multi-year Budget and delivery of the transformation of our health service, because it is through that transformation that we will see savings made by the Department that it can then invest in the Department, meaning that individuals such as our junior doctors will get the additional money that they need.

To do that, we will also need a Programme for Government.

We are happy to support the motion. We salute our dedicated healthcare staff for all that they do, and we send this message to the Executive: stop playing politics with workers' pay, and let us just get it done.

Photo of Liz Kimmins Liz Kimmins Sinn Féin 4:30, 21 May 2024

"Without the workforce, we will only have empty buildings".

Those were the stark words of the representatives of the BMA at the Health Committee on 9 May, detailing the serious situation facing our hospital doctors and GP trainees as the result of years of pay erosion and the growth in staff vacancies. As we have heard today, for the first time, junior doctors voted overwhelmingly in March of this year to take strike action, emphasising just how dire the situation on pay and conditions is. That was in March, and we are here again, two months later, with no progress on the issue. Junior doctors are once again taking to the picket lines — this time for 48 hours — demanding action on pay.

Junior doctors work in the most challenging conditions, looking after sick patients and with huge responsibilities, for as little as £12·50 an hour. It does not take a lot of imagination to see why we are losing junior doctors in their droves when they can earn more doing the same job in the South of Ireland, in Britain or overseas. If we are really serious about tackling the crisis in our health service, that cannot be ignored. A survey by the BMA in 2022 showed that just 7% of medical students here intended to stay and work in the North. After two years with little to no change, I doubt that those figures have got any better.

Like others, I have met the junior doctors committee on a number of occasions. They outlined to the Health Committee their engagements to date with the Minister and his Department. The lack of progress has been disappointing, particularly on moving the pay issue forward. When the Health Committee was told that the suggestion of an increase in pay above the DDRB recommendation as a starting point was given a flat "no", even before the Budget was agreed by the Executive, we were all, it is fair to say, fairly disappointed to hear that. That, ultimately, appears to have closed down any prospect of further negotiations. I am aware that the Minister met the BMA this morning but am not aware of any further progress on that.

There is no doubt that we are all realistic about the financial picture. The Finance Minister continues to challenge the British Treasury on the significant underfunding of public services here. The comments of the Member who spoke previously about the Executive's and our being disingenuous are pretty rich. I do not know what the alternative is to voting for a Budget when we have absolutely no control over how much we have.

We have talked this to death. We want to make progress with full pay restoration, but, in reality, that is not achievable in the here and now. That does not negate our responsibility to progress the issue, find a way forward and give a commitment that we will work towards that.

Photo of Nuala McAllister Nuala McAllister Alliance

Does the Member agree that the junior doctors are wise to that issue? They understand the budget constraints, which is why they have not asked for 30% immediately but have said that it is the negotiation in good faith that is key.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Member has an extra minute.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I thank the Member for her intervention. It leads on to my next point and is exactly the point that we need to hear loud and clear. They are realistic in their expectations. They know that full pay restoration of over 30% cannot be delivered right now, but they want a commitment to work towards it, and, until they have that, they cannot move forward in good faith on any of the other non-pay issues. That is not unreasonable, given that they are still waiting for their 2023-24 uplift. I think that they said in Committee that they had been told that they would get it in June but did not know whether that meant June of this year, next year or another year.

Our health service is, no doubt, running on empty. Primary care is in crisis. Secondary care is in crisis. Social care is in crisis. We see colossal waiting lists and a lack of bed capacity. Staff vacancies, including among our junior doctors, are putting patient and staff safety at dire risk. I do not underestimate the challenges faced by the Health Minister, so I do not want to come across as being too critical, but this will only get worse if we do not address the issues that force valuable staff out of the job that they have trained to do, a job that they love and, in many cases, want to stay in but for their feeling, sadly, that they have no option.

Striking is a last resort for all the doctors who are going back to the picket lines tomorrow. They should not be in that position. I urge the Minister to continue engagement with representatives of the striking doctors to reach an agreement urgently, as his colleagues across the water have been able to do. If the matter is not resolved, patients and healthcare staff will suffer as a result, and that will have huge consequences for our health service for a long time.

Photo of Danny Donnelly Danny Donnelly Alliance

This is a very important motion and one that I am proud to be a co-signatory to with my Alliance Party colleagues.

Junior doctors are a critical part of our Health and Social Care staff, and it is right that we recognise their contribution to the health service, especially given the unprecedented pressures that we have faced in recent years, which were exacerbated by the COVID-19 pandemic and political instability in this place. Junior doctors work in extremely challenging circumstances, with huge waiting lists — the worst in Europe — increasing vacancies across the system and more favourable working conditions being available in other jurisdictions. Personally, I am very aware of the long hours and the high-pressure nature of the junior house officer (JHO) role. For example, when there is a medical emergency on a hospital ward in the middle of the night, it is generally the JHOs who come running when the alarms go.

It is right that junior doctors are paid appropriately, and it is concerning that, in Northern Ireland, pay is significantly lower than everywhere else in the UK. We have heard that from several Members today. According to the BMA, junior doctors in foundation training are paid a basic salary of £26,713 for a 40-hour week; in contrast, in England, junior doctors start on a higher salary of £32,398 a year. Of course, there are differences between here and England, not because of devolution but because there are different contracts and different circumstances with out-of-hours working. We have heard about them already today. Nonetheless, it is unacceptable that those differences in pay are as substantial as they are.

The workforce crisis that we face in our health service is a consequence of many issues, but one key issue in particular is the pay erosion that has occurred since 2008. Calculations from the BMA estimated that junior doctors' pay has been eroded by 30·7% since 2008. That makes Northern Ireland a less attractive location to work and train in than other countries.

We also need to acknowledge that, in addition to pay, wider working conditions remain a difficulty for many junior doctors. With many doctors leaving for better pay and conditions, that leads to greater burdens on the remaining staff and to regular understaffing. A BMA survey of junior doctors indicated that many were unable to take regular breaks or get a decent meal during the long shift hours. Some even mentioned having to sleep on the floor during night shifts in between exhausting jobs due to a lack of rest facilities. In that survey, 60% of junior doctors described their morale as "low" or "very low", and 49% described their physical and mental well-being as "low" or "very low". That is clearly concerning. All of this is much worse than before 2020, given the huge and lasting pressures caused by the pandemic, and things will only get worse until action is taken.

Another challenge that is more specific to Northern Ireland is that pay and conditions are more favourable in other jurisdictions. That is particularly the case in the Republic of Ireland, where doctors living in Northern Ireland can work without having to move. We see that even more with other medical professionals, and we have known about consultants for a while. That is why we cannot simply copy and paste the approach of the Westminster Department of Health and Social Care.

The motion rightly recognises that strikes are a measure of last resort when all alternatives have not worked. We should acknowledge that the vast majority of junior doctors have voted for strike action, with 97·6% being in favour from a 63·7% turnout. The position for junior doctors has been extremely frustrating. First, from 2022 to February this year, there was no Executive or Health Minister in place, and, as has been mentioned, the Secretary of State refused to engage on that basis because health is a devolved matter. However, it has also been disappointing that Minister Swann has insisted that we must wait and see the agreement reached in England before concluding an agreement in Northern Ireland. That has not been the case in Scotland and Wales, which have successfully averted strike action through meaningful engagement and a commitment to pay restoration.

As mentioned before by me and other Members, it is essential that the Minister considers the unique circumstances here and the impact of another jurisdiction being so close and having more favourable pay and working conditions. It has been highlighted that it is only through transformation that we can deliver fair pay, but, without staff, there can be no transformation. Without staff, there is no health service.

The Minister needs to engage productively with junior doctors urgently and do what he can to resolve the long-standing issues. Pay is not the sole motivation of many people working in the health sector; instead, they are motivated by a desire to help those in need. However, we must ensure that those who work in the health service are paid appropriately and at a similar level to their colleagues across the UK and Ireland. It is worrying that 72% of our junior doctors are considering leaving the health service. They are the doctors, GPs and consultants of the future, and we cannot afford to lose them. I encourage the Minister to engage productively with them and to work to resolve the unacceptable disparity.

Photo of Alan Chambers Alan Chambers UUP

First, I pay tribute to all our junior doctors. It has been said many times that they are an integral part of our workforce. While that is true, we must not for one moment underestimate the sheer contribution they make to the health and welfare of patients. It is a simple fact that many of our local hospital services would not be able to function without them. That is why I fully acknowledge that they are a really important part of the workforce and that we need to do all that we can to support and encourage them in their role. Pay and broader terms and conditions are, inevitably, a really important part of that.

Unfortunately, during periods of political stalemate, our junior doctors, just like our Agenda for Change staff and all our other HSC staff, lose out on timely decisions on pay. That is exactly what happened last year, but I welcome the fact that, following the restoration of the Executive, the Minister of Health moved almost immediately to give a commitment that last year's recommendations from the pay review bodies would be delivered. The implementation of the DDRB recommendations for 2023-24 gave junior doctors an average pay uplift of 9·1% and over 10% for first-year doctors, which compared very favourably with the average 2023-24 CPI inflation rate of 6%.

I note, however, that the BMA junior doctors committee is sticking firmly with the call for full pay restoration. While that is absolutely understandable as a broader objective, we, as MLAs, need to be alert to what it means. Junior doctors are by no means the only group of public-sector workers who have seen a degrading of their real pay terms from 2008; in fact, I struggle to think of any such group that has not. That is what a decade of austerity at a national level does, and it has been made worse by a regular absence of political and budgetary certainty in Northern Ireland. Do those who demand full pay restoration for junior doctors also want to see pay restored to our police officers or teachers? More importantly in the context of today's debate, are they asking for a greater pay award to be allocated to our junior doctors than to their health colleagues? The last thing that the House should be doing is promoting disunity between, for instance, our Agenda for Change staff and junior doctors.

A major pay increase would have unintended but major knock-on implications across the health service and the wider public sector. The reality is that there is no bottomless pit of money. Ironically, the other Executive parties that recently agreed the 2024-25 Budget seem to believe that Health has already got enough, but it does not. By his own admission, the Minister has not even got enough resource cash to keep funding existing cancer and time-critical treatments, yet, on top of joining every other populist call for funding, the proposers of the motion suggest that he somehow magics up the extra cash. My colleague the Chair of the Health Committee suggested that junior doctors may not get all that they are asking for and that forward commitments may satisfy them, but I ask the Minister to tell me how he can give commitments to anyone in the absence of multi-year Budgets.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

People's lives and the very future of the NHS are at stake if the Government do not pay our junior doctors properly. Junior doctor workers should not be forced to take strike action; they would rather be treating patients. The desperate state of our health service can be judged by the fact that those life-saving workers are being forced on to the picket lines and, in many cases, forced to go abroad to make a living.

I invite any MLA here to put themselves in the shoes of a junior doctor and then tell us why they should not be given a pay rise or take strike action. Junior doctors in the North have had their pay eroded by some 30·7% since 2008. Not only is their pay less than that of their NHS counterparts but it is less than that of many more doctors across the world. Then we wonder why waiting lists are sky high, emergency departments are rammed and doctors are leaving the NHS in droves. They have long hours, crippling work conditions and pay that is barely above minimum wage. Like all health workers, junior doctors are overworked, undervalued and need to be given a real pay rise if the NHS is to survive. As has been said, 75% of the North's junior doctors are, because of pay and other issues, already considering leaving the North.

Junior doctors are also leaving because Stormont cares little about workers' living standards, patients' health or the health service. If the Executive cared, the money would be found in short order. Tory economic policy kills. It kills the working-class people whose health outcomes are diminished through poverty and alienation. It kills people who are languishing on waiting lists. It kills people in overcrowded and under-resourced emergency departments. It kills the desire of too many workers to stay in the NHS.

Hopefully, we are all in agreement that the Tories have underfunded public services, with catastrophic consequences, but it is that exact policy that the Executive are following. Striking junior doctors can attest to that fact. Across the Chamber, parties claimed that they would sort workers' pay and the health service when the Executive were restored. I ask — I am sure that junior doctors are also asking — this: what is the hold-up? People are right to aspire to have a Government who do more than implement Tory cuts. Junior doctors are right to strike for pay and for the protection of the health service. They will not be fooled by the excuses and hand-wringing of the Executive or the proposers of the motion. The junior doctors' strike, like that of the education support workers, shines a glaring spotlight on the duplicity of this Government — a Government who speak out against Tory policy whilst implementing it through Stormont; applaud the efforts of public-sector workers whilst cutting their pay; bring motions to the Floor of the Assembly to call for the policies and services that they refuse to implement; and underfund the health service, yet give hundreds of millions of pounds each year to the private healthcare sector.

The Executive's refusal to explicitly support the junior doctors' strike is unsurprising, given Stormont's long-term neglect of those workers. Crucially, the strike poses a serious question: if the Government cannot deliver for health workers, patients and the health service, what is the alternative? We desperately need an alternative. We can no longer accept the erosion of pay, forced migration of health workers, compromised patient safety and the decline and gradual privatisation of the health service. In my view, the alternative will be shaped through strikes like that of the junior doctors tomorrow. It is workers who keep society afloat. Workers have the solution to the problems that we face. They have the power to shape the future. That may start with their pay demands, but it should not end there. My message to them is that they should keep up the fight and continue to demand a National Health Service that delivers on its aim of providing free and accessible healthcare for all.

Victory to the junior doctors, victory to the strike and victory to the NHS.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party 4:45, 21 May 2024

The health service depends on junior doctors. They make enormous sacrifices and hold enormous responsibility, and their pay and working conditions should reflect that. Junior doctors hold our lives in their hands. They sacrifice so much of their own lives and health to safeguard ours. They deserve so much more than their current pay and working conditions.

We hear a lot about patient safety. There is a major emphasis on it. It acts to give carte blanche to and justification for the reduction or removal of vital services. What consideration has been given to the safety and welfare of overworked junior doctors, or to how their burnout impacts on overall patient safety? There is anecdotal evidence of a trend of a mass exodus of junior doctors and other healthcare staff from hospitals in the North, particularly those in outer areas, such as Altnagelvin Area Hospital, Daisy Hill Hospital and the South West Acute Hospital, to hospitals and health settings in the Republic, where an additional 20-minute commute can result in a doubling of income overnight. How does that interact with the Department's repeated assertion that the inability of trusts to recruit and retain medical staff or specialists at so-called peripheral hospitals is necessitating service reconfiguration and withdrawal?

Calls for courage from elected officials with respect to administration and reform of the health service are well documented, but would it be more appropriate to characterise those demands as calls for conditional courage? In other words, is it appropriate to define the scope of health service reform as being focused entirely upon the reconfiguration and withdrawal of hospital services? The goodwill of professionals who have dedicated their lives to taking care of others should not be taken advantage of as a means of sustaining the health service. That goodwill rightly enjoys all our respect and admiration, but it is crucial to recognise that it is not infinite and should not be taken for granted. Surely it is more appropriate to recognise that a major contributing factor to staffing shortfalls at hospitals is the atrocious pay and conditions for our health service workers. Surely it would be more appropriate to tackle the crux of the issue, rather than its outworkings. In other words, should we not treat the disease that is ailing our health service as opposed to the symptoms?

Pay junior doctors what they deserve. Fair pay now.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The next person to speak is the Minister of Health, Robin Swann. Minister, you have 15 minutes.

Photo of Robin Swann Robin Swann UUP

Thank you very much, Madam Principal Deputy Speaker. I am grateful to the Alliance Party for bringing this issue to the Floor of the Assembly today, because I want to acknowledge the vital contribution of our junior doctors to the health service, their commitment and expertise and the long hours that their jobs have long involved. It has always been a tough and demanding job, and the current extreme pressures on our hospitals have, undoubtedly, significantly exacerbated that.

I fully understand the frustration behind the latest phase of industrial action, and I respect the mandate that the BMA junior doctors committee has received from its members. However, I deeply regret the decision to strike again, because it will cause serious disruption to patient care at a time of already significant and prolonged stresses on the service. Therefore, I again question what the industrial action can hope to achieve in a Northern Ireland context. This is a national dispute that will only be resolved at a national level. For reasons that I will set out, it is beyond the Executive's remit and the resources that have been provided to us to provide a unilateral solution.

I begin by correcting a factual inaccuracy in today's motion, because, as things stand, no agreement has been reached in Wales on junior doctors' pay. Indeed, the 5% pay increase for 2023-24 that has been implemented in Wales was lower than the corresponding uplift in Northern Ireland. Wales has not yet matched the 2023-24 recommendations of the DDRB, the national review pay body for doctors in Northern Ireland. While that situation may yet be updated, that is the current factual position. I am sure that Members will want to correct the record in that regard, because I know that a number of them mentioned Wales.

Let me assure the Assembly that, as far as I and my Department are concerned, my Department's negotiations with the BMA junior doctors committee have not closed down. The talks have not collapsed. Indeed, there are important issues of real substance to be progressed. Our doors remain open. I had a very open and amicable engagement with members of the junior doctors committee earlier today, and I reiterated that point to them. On taking up office, I met the BMA central committee on the matter.

Officials from the Department have met the BMA junior doctors committee on a number of occasions and will continue to do so. While the negotiations are, quite properly, led on my Department's side by our workforce negotiating team, I remain across the detail and will continue to do all in my power to facilitate progress. That has been detailed in my letters to the junior doctors committee in which I set out my Department's position and offered independent arbitration in the talks. To date, that offer, which I made again this morning, has not been taken up.

What I will not do is make promises that cannot be fulfilled. Populist gestures might be good for headlines and photo opportunities on picket lines or, indeed, in social media videos, but they do not help to resolve the situation. The reality is that, at the heart of what is a national dispute, there is a demand for pay restoration for what would be a landmark pay settlement that reverses the below-inflation increases from over the past decade and more. I am sure that many in the House have sympathy with that cause, but it must be remembered that public-sector pay restraint has been a core element of UK Government policy for 10 years and more. It has been a centrepiece of austerity and, inevitably, has impacted on all public-sector pay awards in Northern Ireland over time. It was reflected in public-sector pay policy, which the Department of Finance actually set and, indeed, in pay awards that were given by previous Northern Ireland Health Ministers, some of whom are still in the House today, and by Ministers in other Departments.

All our public-sector workers were impacted by pay restraint, so pay restoration spans our entire public sector. I want to set that in context. If we had that mythical, magical money tree to shake and if I were able to commit to the BMA's request for a 32% uplift for our junior doctors, even over a longer term, that would require a further £52 million per annum before any other pay awards were considered. Amending the public-sector pay policy, which was adopted UK wide for all our employed doctors and dentists, would require an additional sum of over £210 million each year before pay awards. I do not believe that the House would want me to make an exception just for junior doctors in that regard.

I could not turn to nurses, paramedics, social workers and social care workers and say, "Sorry, this special pay uplift is not for you". If we gave that tree another shake, we could maybe dislodge another £1 billion, which Agenda for Change staff would seek to restore their pay levels. Likewise, other Ministers would not relish delivering the same message to teachers, police officers, civil servants, public transport workers and all the other workers in key services. That, in a nutshell, is why pay restoration is not just a cross-cutting issue for the Executive but an issue that they cannot resolve, given their limited fiscal headroom and current acute budgetary pressures. Therefore, we must realise those hard realities.

Members have asked about business cases. I advise the House that I have written to the Finance Minister to propose a comprehensive independent review of public-sector pay in Northern Ireland that will look at a range of issues, including comparisons with neighbouring jurisdictions and recruitment and retention considerations. I have asked that that include not just the estimated costs of full pay restoration but the potential cost to public services, if pay erosion is not addressed. Therefore, I fully accept that that is an important issue, but I stress again that the responsibility rests with those whose policies created the situation, namely, the Westminster Government.

That is not to say that progress in other areas cannot be made between my Department and the BMA junior doctors committee. Some of those issues have been raised here today, and real progress has been made since the Executive returned. When the ballot for industrial action was launched, junior doctors, like those in the rest of the health service, had received no pay award for 2023-24. We have put that right, implementing in full the recommendations of the pay review body — the independent DDRB. That award will be paid in the June pay run, landing in pay packets next month.

The reason for that timeline is that I had to wait to receive that money from the Department of Finance, which had to wait to receive it from Westminster as part of the restoration package. It was not the case that we, the Department of Finance or, indeed, the Business Services Organisation (BSO), as the paying authority, were sitting on that money and not moving. It is a fact that we moved as quickly as we could once we received it.

It is misleading to look solely at basic pay rates when making comparisons with other jurisdictions. Junior doctors in England have a different contract that involves a higher basic pay rate than that in Northern Ireland, but they have lower additional payments, such as banding allowances, which are paid as an additional percentage of basic pay and which vary according to the rota that an individual doctor works. Again, that is why my Department and I are putting so much emphasis on that contract renegotiation with the junior doctors committee in Northern Ireland. It was indicated at the meeting that we had this morning that that would be a first for Northern Ireland.

We have delivered a new contract for our GPs under the GMS, which we talked about during Question Time. It has stepped outside the bounds of what would normally have been done. I firmly believe that, by engaging with our junior doctors committee, my departmental officials can do that again for Northern Ireland to address the other issues that have been raised today. I recognise that the junior doctors committee's mandate is on pay. This morning, I asked the committee whether we could look at a dual-track approach, looking at the contract while continuing the conversations about pay. The vast majority of our doctors work in rotas, which attracts that conversation and that additional payment that was mentioned earlier. That is the construct of the current Northern Ireland contract, and we are willing to engage on it. Comparisons with Scotland have been made, but those are complicated by a different income tax rate there. As always, it is not about the headline but about the take-home pay.

I will conclude with two points. First, I urge the BMA junior doctors committee to continue to engage, notwithstanding the wholly unacceptable Budget settlement for Health. There are real issues of substance to discuss and make progress on. My Department is clear that implementing the DDRB-recommended package will not bring an end to pay discussions with the BMA. For example, a set moment is ongoing in the junior doctors' dispute in England that could result in further funding becoming available to Northern Ireland through a Barnett consequential. It would, of course, be a matter for the Executive to decide how such funding would be allocated. My argument and my position are that, if funding comes through a settlement in England, it should be allocated to my Department so that we can recognise our junior doctors and implement the funding for them here. I would look for support from the other Executive parties to secure that. Secondly, ahead of national DDRB recommendations for 2024-25, discussions on contract reform and non-pay terms and conditions can still be progressed. That is the route to making real improvements in the working conditions that were recognised and talked about today in what I firmly believe is an out-of-date contract.

With respect to Members, I conclude by emphasising that the Budget that the Assembly is poised to endorse next week will make progress on pay much more difficult, not just for junior doctors but for all health service workers. It is not me who says that; it is the Northern Ireland Fiscal Council, which referred to that in its last report on pay awards and the pressures that they will bring. It is not uncommon for some in the House to brush aside concerns about budget cuts with bland and grand pronouncements about efficiency savings, but the budget that the Executive are handing Health for this year places even more severe limits on what can be done on junior doctors' pay. Do not take my word on that; in a statement issued on Thursday 25 April 2024, the BMA said that the allocation:

"is simply not enough to sustain a health service that is struggling to function effectively".

Yet here we are. The party that tabled the motion and proclaimed to the world how much it supports junior doctors actually supports the Budget. You could not make it up.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance 5:00, 21 May 2024

I thank the Minister for giving way. Does he agree with me and disagree with the Chair of the Health Committee in saying that it is not simply the case that the Minister of Finance's only option is to present that Budget but that she can present a new, improved Budget that includes pay for junior doctors, education workers and others?

Photo of Robin Swann Robin Swann UUP

As the conversations with the BMA are ongoing and have not concluded, I think that there is an opportunity for the Executive to look again at the Budget that has been presented. I recognise the welcome work that the Minister of Finance has completed recently on the fiscal framework and the fact that she is in Westminster today to engage further. I do not know why we would shackle ourselves to a Budget that was previously presented when there is still an opportunity for more money to come forward before we have to take an Executive decision.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

Will the Minister give way? On the back of that, it is important that I correct the previous Member who spoke. It is not up to the Finance Minister to decide how the Department of Education spends its budget or how the Department of Health spends its budget. She makes the allocations on a very limited Budget. However, the Minister noted the developments on the fiscal framework, and that is welcome. I congratulate my colleague Caoimhe Archibald for going over to the British Treasury and fulfilling the commitment to ask for more money. That is what is needed, and it is why we are in this situation.

Photo of Robin Swann Robin Swann UUP

The Chair of the Committee will know that I have recognised that this job is tough, but being Finance Minister in Northern Ireland at this time is on a comparable footing. I therefore commend her for the work that she is doing. What I do not agree with, however, is the allocation, agreed by the other Executive parties, that has been given to Health.

The BMA statement of that date also went on to say that the Northern Ireland Executive need:

"to be absolutely honest with the public about what health service they can expect as a result of this budget as it is clear it will be impossible to match any expectation."

I, for one, am being totally honest about the Budget. It is still, as I have said, not too late for others to join me. As a parent, I sometimes worry about how best to explain the meaning of irony to my children, so I am grateful to Members for providing an excellent example that I can bring to their attention in the future.

Some Members:

Hear, hear.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

I call Paula Bradshaw to wind on the motion. Paula, you have 10 minutes.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you, Madam Principal Deputy Speaker. I thank all the Members who spoke, and the Health Minister for responding. All contributors were united in how they spoke about how valuable our junior doctors and our entire health and social care workforce are. That fact was highlighted by Alan Chambers and the Health Minister. My colleague Nuala McAllister rightly outlined the clinical training that junior doctors go through and the reality of what their week is like in their place of work.

Today, I was contacted by a junior doctor who told me that junior doctors are responsible for their fees for their exams. That particular constituent said that they have to find £1,650, and that really cuts to the heart of some of today's contributions on how the strikes were a last resort as a result of their being under so much pressure. We therefore have to be careful how we frame such issues, because, fundamentally, we are talking about patient safety. My colleague Justin McNulty highlighted that point. If we have junior doctors, who are an essential part of our system, becoming tired as a result of impossible rotas and working under unreasonable contracts, it is not just they who suffer but, first and foremost, the patients. Do you want to be seen by someone who is suffering from fatigue, an issue that Alan Robinson highlighted, and who, justifiably, is feeling undervalued, which is the word that Declan Kearney used? Having gone through the rigorous training that Nuala mentioned, junior doctors find that their workplace does not even have a hook for them on which to hang their jacket. Other Members commented on that as well. Low pay is therefore only part of the problem. It is a symptom, however. Pay is now so low and so far behind that of our neighbours that junior doctors justifiably regard it as a core issue. My colleague Danny Donnelly highlighted that point.

The Minister is developing a reputation for not wanting to meet anyone. In correspondence, he turned down an invitation to meet the bereaved families of the victims of Dr Watt. Coincidentally, he was willing to meet the junior doctors only when this motion appeared in the Order Paper. What correspondence the Minister has had with junior doctors suggests that a solution could take the form of contract reform, but that has not really started, nor has there been any movement on back pay yet. I was glad to hear today that junior doctors will be receiving that in their pay packet in June, which Alan Robinson mentioned. Alan Chambers rightly pointed out that junior doctors did receive an uplift of 9·1%, and I am grateful for the figure. The Minister said that, in the future, the progressive realisation of back pay would cost £52 million before any other pay settlements. We are dealing with harsh numbers here, colleagues, but it is not remotely good enough to suggest that Northern Ireland cannot advance the issue before —.

Photo of Nuala McAllister Nuala McAllister Alliance

Regarding those harsh figures, does the Member also agree that, because of burnout, gaps in the system and vacancies, the cost of locum junior doctors is astronomical? It is a vicious circle. You are not saving or investing; instead, you are spending more.

Photo of Paula Bradshaw Paula Bradshaw Alliance

I thank my colleague. I fully agree. The chief executives from the health and social care trusts have been saying for many years that they want to see reform in that space.

We need to move forward with this issue. Health is a devolved area, and this is how it works. A number of Members — Nuala McAllister, Alan Robinson and Danny Donnelly — mentioned the fact that it is a national dispute. The Minister said that it will be agreed and settled nationally. He raised the issue about Wales. Wales, in fact, is discussing additionality for 2023-24, unlike here, and it wants to advance negotiations further. The matter has not been settled in Wales, and that fact needs to go on the record.

There are different issues in Northern Ireland. Our contracts are more hopelessly outdated, and there is the temptation of working for Sláintecare right next door. Obviously, a lot of large health trusts over in England offer very attractive packages. Morale is, inevitably, much lower here than in other parts of the UK. Alan Robinson highlighted retention as a major issue, as did Gerry Carroll, who called it "forced migration".

The Department of Health receives £4,300 for every person in Northern Ireland as a starting point before Barnett consequentials are introduced. That amounts to more than half of the entire devolved Budget. We have seen countless audits of departmental spending, one of which the Health Minister referenced. For example, according to the Fiscal Council, managing hospitals in the same way as they are managed in England would save over £400 million a year while, at the same time, delivering improved patient outcomes. Let me put that another way: we are spending over £400 million a year to deliver worse outcomes. The fact is that we need to see value for our health spend, yet we see money being allocated to outdated systems and approaches rather than to reformed contracts and improved pay conditions for the people working in the health service.

Colin McGrath highlighted the fact that we need to focus on ways in which we can incorporate transformation to address the issues that the junior doctors raised with us all. We have said endlessly that no element of our healthcare system is more important than the people working in it. If they feel, justifiably, that they are not being treated fairly and their legitimate concerns are not being taken seriously, there will be no healthcare system left to budget for.

Liz Kimmins, Colin McGrath and others raised the issue that junior doctors are taking to the picket lines tomorrow for 48 hours as a last resort. The Health Minister said that he respected their right to strike but raised concerns about the impact that the strike will have on patients. We need to hear less about how £4,300 per person is not enough. We need to hear from the Minister about how he will prioritise his spending so that the key drivers of the system — the people in it — are compensated and treated fairly while the system is transformed to remove waste and deliver better outcomes.

The motion is clear in calling for the Minister to:

"urgently and meaningfully engage with the British Medical Association" to deliver a fair settlement. He indicated that his door was open and that he would be up for independent arbitration. That will, hopefully, be the starting point for the BMA to be able to sit down with the Health Minister and others to mediate that. We cannot see more of our junior doctors and others leaving the health service and working in neighbouring jurisdictions. If that keeps happening, there will be no health service left.

The Health Minister's suggestion to the Department of Finance of a review of public-sector pay is certainly welcome, but I refer to my colleague Nuala McAllister's point about putting the business case for more funding to the Finance Minister. That is probably a more pressing matter at this stage. We must consider the priorities that we need. We need to be proactive. After all, if there is no value in the health system, what does that say to the staff working in it? We need to be able to recruit and retain our staff.

I think that I have covered most of the debate. I will leave my remarks there, but I hope that we will see movement in this area, because we have to show our junior doctors how much we value them and how much we care that they stay in our system.

Question put and agreed to. Resolved:

That this Assembly recognises the valuable work of all staff within Health and Social Care (HSC) Northern Ireland, as well as the unprecedented pressures facing our health and social care system; acknowledges that junior doctors are a vital element of the health system in Northern Ireland; notes that junior doctors in neighbouring jurisdictions currently experience better pay and conditions for less-pressurised workloads than their counterparts in Northern Ireland, causing significant issues for recruitment and retention; further recognises the upcoming strikes are a measure of last resort; and calls on the Minister of Health to urgently and meaningfully engage with the British Medical Association regarding junior doctors' pay, taking account of agreements reached in Scotland and Wales.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin 5:15, 21 May 2024

I ask Members to take their ease during a change of personnel at the top Table.

(Mr Deputy Speaker [Mr Blair] in the Chair)

Motion made: That the Assembly do now adjourn. — [Mr Deputy Speaker (Mr Blair).]